Anaesthesia
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Kidney disease, both acute and chronic, is commonly encountered on the intensive care unit. Due to the role the kidneys play in whole body homeostasis, it follows that their dysfunction has wide-ranging implications and can affect prescribing and therapeutic management. ⋯ We discuss how early involvement of specialist nephrology services can improve outcomes in patients with kidney disease as well as offer valuable diagnostic and specialist management advice, particularly for patients with established end stage kidney disease and patients who are already known to nephrology services. We also explore some of the ongoing research questions that need to be answered within this arena.
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Liver injury or failure is observed in up to 20% of patients admitted to the intensive care unit and is associated with poor prognosis. Timely recognition and initiation of appropriate management are the most important steps in minimising adverse outcome for patients. Distinguishing between primary or secondary liver failure, and between acute or chronic liver disease aids appropriate management. ⋯ We focus on interpretation of patterns of deranged liver biochemistry and the necessary investigations required to identify the related aetiologies. We also propose an evidence-based approach to the management of liver failure and its extrahepatic manifestations. This review, in addition, clarifies when to seek expert advice or refer patients to a tertiary centre.